Wound ± types, healing process; requirement of wound dressing; an overview of wound care materials - study of various kinds of wound care dressing and advanced wound dressings;

Definition: ‡ An injury to any part of the body ‡ External injury in which the skin is torn, cut, or pierced

Classification of wounds
1. Intentional Vs. Unintentional. 2. Open Vs. Closed. 3. Degree of contamination. 4. Depth of the wound.

Example: operation or venipuncture. Example: fracture in arm in road traffic accident. Unintentional wounds Intentional wound: occur during therapy. .Intentional Vs. Unintentional wound: occur accidentally.

Closed wounds Open wound: the mucous membrane or skin surface is broken. Closed wound: the tissue are traumatized without a break in the skin.Open Vs. .

are primarily closed wounds. . There is no evidence of infection. Clean ²contaminated wound: are surgical wounds in which the respiratory. genital.Degree of contamination Clean wounds: are uninfected wounds in which minimal inflammation exist. alimentary. or urinary tract has been entered.

. Dirty or infected wounds: includes old. accidental wounds. fresh. There is evidence of inflammation.Degree of contamination Contaminated wounds: include open. accidental wounds containing dead tissue and evidence of infection such as pus drainage.

subcutaneous tissue.Depth of the wound Partial thickness: the wound involves dermis and epidermis. epidermis. Full thickness: involving the dermis. and possibly muscle and bone. .

Protective quality. which produce keratin.Anatomy of Skin Epidermis:  composed of several thin layers:  the several thin layers of the epidermis contain the following: a) melanocytes. . a pigment that gives skin its color and protects it from the damaging effects of ultraviolet radiation. a water Repellent protein that gives the epidermis its tough. which produce melanin. b) keratinocytes.

lymph. nerve fibers. Subcutaneous Tissue: composed of a fatty layer of skin that contains blood vessels. nerves. .Anatomy of Skin Dermis: composed of a thick layer of skin that contains collagen and elastic fibers. sweat and sebaceous glands. and loose connective tissue filled with fat cells. blood vessels. and hair follicles.


Stage I .

Stage II .

Stage III .

Stage IV .

Wound Healing Process .

Exact biologic process that takes place in orderly sequence An exudate containing blood. and fibrin begins clotting and loosely binds the cut edges together Blood supply to the area is increased. and the basic process of inflammation is set in motion Leukocytes increase in number to fight bacteria in the wound area and by phagocytosis help to remove damaged tissues The served tissue is quickly glued together by strands of fibrin and a thin layer of clotted blood. lymph. forming a scab .

Wound Healing Plasma seals to the surface to form a dry protective crust This seal helps to prevent fluid loss and bacterial invasion During the first few days of wound healing. a tough fibrous protein responsible for the structural integrity of the skin . connective tissue cells (fibroblasts)rapidly proliferate and give strength to the wound by producing collagen. the seal has little tensile (The resistance of a material to a force tending to tear it apart) strength After 3-4 days .

granulation tissue (fibrous connective tissue)includes blood vessels and lymphatics that proliferate from the base of the woind Rapidly growing and multiple epithelial cells begin to restore the epithelial continuity of the skin At this stage the wound appears healed. healing is not complete until the granulation tissue organizes into scar tissue .Wound Healing At the same time small blood vessels regenerate and build new blood channels.

size and location of the wound. and stresses put on the incisional area During this time the scar (cicatrix)strengthens as the connective tissue shrinks .Wound Healing By the ninth or tenth day. the wound is moderately well healed and then becomes progressively stronger The whole process of repair takes 2 weeks or more depending on factors such as physical condition of the patient.

Wound healing phases Inflammatory phase Proliferative phase Maturational phase .

Inflammatory phase The body·s defenses are aimed at limiting the amount of damage and preventing further injury .

platelets release coagulation factors and cytokines to initiate the healing process .Inflammatory phase At the initial time of tissue disruption.

Inflammatory phase Within the first day following tissue injury. neutrophils attatch to surrounding vessel walls and then move through the vessel walls to migrate to the wound site .

Proliferative phase angiogenesis fibroplasia epithelization .

VEGF. heparin.Angiogenesis The process of new blood vessel formation to support a healing wound environment Stimulants . FGF-1.. tissue hypoxia ² major stimulus TNF. FGF-2 .

. which in turn attract fibroblasts. The fibroblasts then repair the site by producing new connective tissue matrix.The fibroplasia phase is characterized by movement of wound macrophages into the site of injury.

Maturational phase ( = remodeling ) The period of scar contracture with collagen cross-linking. shrinking. and a loss of edema .

The remodeling phase is characterized by an equilibrium between collagen synthesis and collagen degradation in an effort to reestablish the connective tissue matrix. .







respiratory impairments. advanced age. malnutriion. cancer . anemia. cardiovascular. presxisting condition as diabete. obesity. stress level. Overall physiacal and psychological condition .Factors influencing wound healing Other factors pat age.

Wound Dressings Requirements ‡ ‡ ‡ Light Weight Flexible Odor Free Impermeable to microorganisms Permeable to water vapor. exudate ‡ ‡ . oxygen.

Study of Various Kinds of Wound Care Dressing and Advanced Wound Dressings .

Wound Dressings ‡ protect from contamination helps with absorption of exudate provide immobilization (bolster over skin graft). nonadherence Rate of epithelialization is twice as fast in a covered wound surface ‡ ‡ ‡ .

acticoat) Absorptive class: wide-mesh gauze. Dakin·s solution. bacitracin. xenograft.Classes of Wound Dressings ‡ Nonadherence fabrics: fine-mesh gauze. ointments and solutions: zinc oxide paste. biologic (allograft. Sulfamylon. supplement with a substance to augment its occlusive or antibacterial properties (xeroform. silvadene. foam dressing (lyofoam. skin substitutes such as Alloderm) Cream. acetic acid. ‡ ‡ ‡ . curafoam«) Occlusive: Nonbiologic (tegaderm).

Dressing Choice Wound Type Goal Black/ low exudate Yellow/ high Exudate Yellow / low exudate Rehydrate/debride Remove slough Control exudate Remove slough Control exudate Superficial Wound Hydrogel Hydrocolloid Hydrocolloid Exudate Absorbers Hydrogel Hydrocolloid Film Cavity Hydrogel Hydrocolloid Hydrocolloid Exudate Absorbers Foam dressing Hydrocolloid Exudate Absorbers Foam dressing .

Dressing Choice Wound type Red/ high exudate Goal Absorb exudate Maintain moist environment Promote granulation Superficial Foams Hydrocolloid Exudate absorbers Hydrogel Hydrocolloid (thin) Film Cavity Hydrocolloids Exudate Absorbers Foam cavity dressing Hydrogel Hydrocolloid Foam dressing Red/ low exudate Maintain moist environment Promote granulation .

Used as primary dressing with wounds substantially or fully granulated If there is black eschar or yellow slough. . ‡ ‡ Not used if wound is producing heavy exudate.Wound Dressings-Hydrogels ‡ Used to keep wounds moist Clear viscous gels protect wound from desiccating ‡ ‡ ‡ If wound is infected. the necrotic tissue should be removed. hydrogel serves no purpose.

Wound Dressing-Hydrogel Sheets ‡ Non-adhesive and will not stick wound base Keeps wound moist Protects against contamination Capable of absorbing exudate Promotes healing Secured to wound: gauze or tubular bandage ‡ ‡ ‡ ‡ ‡ .

Wound Dressing-Hydrogel gauze ‡ Combination of gauze and hydrogel in same package ‡ Should be used on wounds free of necrotic tissue and /or infection .

Wound Dressings-Hydrogel Applications ‡ Used daily for 30 days 3 ounces of gel per wound depending on how large the wound is. ‡ ‡ .

‡ ‡ ‡ ‡ . Fibers are soft in texture and easily pulled apart. Applied to wound beds to absorb exudate and transudate ² keeping the wound moist.Wound Dressing .Alginates ‡ Made from seaweed Formed into flat squares or sheets of unwoven fibers into twisted robes or pads. Primary dressing for wounds that have moderate to heavy exudate.



Form a gel like plug which absorbs 20 times its weight Held in place by secondary dressing(MVPF, hydrogel sheet, gauze) Doesn·t cause infection or inflammation



Wound Dressings-MVPF
Moisture Vapor Permeable Film Adhesive film dressing, waterproof but allow passage of O2 and H2O vapor from site Prevent desiccation and bacterial contamination Moist healing environment, retain growth factors Promotes autolysins of necrotic tissue in bed Translucent, help clinician visualize wound

Wound Dressings-MVPF

Uses: ‡ Secondary dressing over wounds with high shear

Adhere better to protect light to medium exudate May be left in place for days with uninfected wounds Hold primary dressing in place



surfactants.Wound Dressings-Cleansers ‡ Solutions contain water. salt Wash and irrigate wounds with mild pressure Wet wound to wash out exudate Makes debridement easier ‡ ‡ ‡ .

Wound Dressings-Hydrofiber ‡ Exudate Absorber Held in place by secondary dressing Keeps wound moist yet absorbs excessive exudate ‡ ‡ .

Wound Dressings-Foams Highly absorbent primary dressings composed of hydrophilic polyurethane foam .

absorbs exudate Can be placed in wound to fill bed while absorbing continuous exudate Remains in wound for 3-4 days ‡ ‡ .Wound Dressings-Foams ‡ Keeps wound environment moist.

Wound Dressing-Hydrocolloid ‡ ‡ ‡ ‡ ‡ ‡ ‡ Contains an active matrix Creates a gel like dressing Gel may be formed with in wound bed or on dressing Allows wound to autolytially bebride itself Impermeable to water vapor. and bacteria Not adherent to wound bed. O2. removed w/o tearing granulated tissue Best with light to medium exudate .

remains intact because it can adhere to WET TRACK Do not use on infected wounds May have foul odor after 2-4 days ‡ ‡ .Wound Dressings-Hydrocolloid ‡ Placed on wet wounds and wet surrounding skin.

Advanced wound dressings .

Wound Dressings-Tissue Engineering ‡ Science of creating functional tissues or organs Potentially has a dramatic effect on medicine by providing physiologic implants for tissue regeneration Products ‡ Dermagraft ‡ TransCyte ‡ Apligraft ‡ ‡ .

Wound Dressings-Dermagraft ‡ Human living dermal replacement Designed for the treatment of skin ulcers Provides a living metabolically active human dermal tissue that interacts with the wound bed Produced by seeding dermal fibroblasts onto scaffold of bioabsorbable material Advantages: ‡ Accelerates healing bye introducing collagens. growth factor. ‡ ‡ ‡ . matrix proteins.

Wound Dressings TransCyte ‡ Human based temporary skin substitute Treatment for second and third degree burns Advantages: ‡ ‡ ‡ ‡ ‡ ‡ Easy application and removal Faster healing time with less inflammation One time applications Decreased hospital periods .

advancedtissue.com/transcyte.html .Wound Dressings: TransCyte ‡ ‡ ‡ Consists of dermal tissue and synthetic epidermal layer Provides a temporary covering to protect wound from fluid loss and infection Remains in place until sufficent skin grafting is available or until healed http://www.

US Comvita. France. 3M Area Labs. US Johnson & Johnson Nycomed Pharma. Imedex Biomateriaux.Med Technologies. NewZeland. Norway ‡ ‡ .Players dealing in innovative/ advance Wound Dressings ‡ ‡ ‡ ‡ ‡ Kimberly clark Smith & Nephew ‡ ‡ Quick.

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